Sometimes the cure is worse than the ill: an occasional look into the life of LSE DESTIN 2010

Missing Women and the Abortion Dilemma in India

I recently listened to a reportage on Radio France International which draws the attention to the systematic bias against girls in the Indian society which results in the phenomenon of selective births whereby families resort to abortion if the fetus is female. The 2011 census has in fact shown that the phenomenon of gender selection at birht is getting worse with only 914 girls aged under 6 per 1000 guys. The issues is very complex and cannot be exhaustively explored in a blog post. However, there are two points which are attention worthy. The first has to do with why families prefer sons vis-à-vis daughters ; the second has to do with the measures put in place to counter this phenomenon and the dilemma facing public health officials.

Why? The reportage explains that the preference for sons is very rational if regarded from an economic perspective: families with daughters have to pay in fact a dowry to the family of the groom and the inheritance is by law only recognized to the son of the family. In addition, it is the son who is expected to cater for his ageing parents and therefore the latter regard the son as substitute of an absent social security system. Given this perception of girls as economic burdesn one would expect that sex selection at birth would be greater in poorer states and in poorer households (they have less means therefore they want to avoid the additional economic burden of paying a dowry). However, this is not the case, as some of the richest states such as Punjab and Gujarat are the one with the most skewed gender ratio. This points to the fact that cultural norms (such as the higher social status associated with having a son) might play a bigger role vis-à-vis economic factors. The fact that sex disparities rise with income and education can also point to a different mechanism through whihc these variables influences the outcome: i.e. richer and more educated people have more means to pay for ultrasound scanning, to find the sex of the fetus and therefore to resort to abortion if they wish.

Prevention Measures. Different states in India have put place strict measures to counteract this phenomenon. Since 1972 abortion is legal only for very specific cases i.e. risk to die of the mother, complication for the health of the child, failure of a contraceptives. Similarly, ultrasound scanning has been outlawed if performed exclusively with the purpose to find out the sex of the fetus. These restrictive measure however have done little in preventing families from finding out and choosing the sex of their children and have pushed abortion into illegality. As a result, abortion has become a business which generates million of euro every year. This in turn has created an incentive rather than a disincentive for doctors to perform more and not less abortions. Given the failures so far, authorities in Bombay are trying to make abortion even more difficult to access (changing the limit from the 12th week to the 10th week of pregnancy). These measures are however likely to achieve little result in the direction of discouraging couples from selecting the sex as long as the root causes (see the why discussed above) are not understood and addressed. And if not effective in avoiding sex selection, outlawing abortion (or restricting the cases when it can be legally accessed) could have dire consequences on maternal mortality. There is evidence in fact that unsafe abortions and related complications are key drivers of maternal mortality. The case of India is interesting because it is one of the few developing countries where abortion is legal. Yet, two safe abortions are performed for every three unsafe because 70% of the women are located in rural areas while health facilities are located in urban areas. Making abortions more difficult to get also in urban areas would worsen this trend. Given this unintended consequences, public health officials are confronted with a dilemma: on one hand, they are pushed to make the access to abortion more difficult to reduce the selection of gender at births; on the other hand they are pushed to legalize and facilitate the access to abortion to reduce the number of mothers dying while delivering.

In sum sex selection at birth remains a great problem in India. As the underlying causes such as social customs and economic factors are hard to change, public health authorities have so far looked at restrictive legislation about abortion as a mean to reduce such phenomenon. However they face dilemma as quick fixes which address the symptoms (resort to abortion) rather than the causes might have not only little impact in reducing the genocide of female fetus but also have negative consequences on other health indicators such as maternal mortality.